Epidemiological, Clinical Aspects and Treatment of Victims of Sexual Abuse in the Gynecology and Obstetrics Department of Pikine National Hospital in 183 Cases

Introduction: Sexual abuse or sexual assault is part of violence against women, as is physical violence, female genital mutilation and forced marriage. According to the Criminal Code, this is any sexual offense committed with violence, coercion, threat or surprise on the person of others. It is a criminal act punishable by the laws in force in almost every country in the world. Study Objectives: 1) draw up an epidemiological profile of female victims of sexual abuse;2) develop the treatment protocol. Methodology: This is a 7-year descriptive retrospective study from January 1, 2010 to December 31, 2016 at the Center Hospitalier National de Pikine (Dakar). Included in this study were all of the patients admitted during our investigation period who were the victims of suspected or certain sexual abuse, with or without requisition. For each case, the following parameters were studied: the epidemiological characteristics (age, gestation, parity and place of residence), the circumstances of the attack (time and place), the characteristics of the aggressor (age, link with the victim, number of aggressor), the type of sexual contact, the possible lesions found during the physical examination (genital and extra-genital), the mode of admission, the delay of the consultation, the attitude after the sexual abuse, the gynecological and obstetrical status of the victim, the repercussions and psychological follow-up, the paraclinical assessment, the treatments administered. Data were collected using a survey form and analyzed with SPSS software. Results: During the study period, 183 victims of sexual abuse were received and treated at the level of our structure out of a total of 39,760 patients, representing a frequency of 0.46%. The age of the victims varied between 2 and 36 years with an average of 13 years. The 11 to 15 age group was the most represented. Students were the most represented among victims of sexual abuse (87.4%). Workers represented 9.3% of the victims. Infants made up 3.3% of the victims;the average age of the alleged attackers was 31 when they were known to their victim. Half of the victims (50.3%) were in the pre-pubertal stage. Among those who were in genital activity (91 cases or 49.7%), 16 cases of pregnancy were reported;which represented 8.7% of cases. Only 20.2% of victims had genital trauma. Prescription of emergency contraception was carried out for 47% of the victims who were in genital activity. After the clinical examination, 17% of the victims had received antibiotic prophylaxis. Conclusion: Sexual abuse is currently a real socio-cultural drama. Preventing them involves raising public awareness. Their management must be early and adapted in order to prevent sexually transmitted infections and psychological consequences.

Fetal Instrumental Extractions at the Maternity Section of the Dakar Nabil Choucair Health Centre (Senegal) in 2017: Epidemio-Clinical Aspects, Indications and Prognosis

Introduction:?An instrumental extraction is performed in order to shorten the phase of expulsion of the fetus outside the maternal pelvic pathway, when there is a suspected fetal state or a defect in progression of the fetal mobile. It can be responsible for immediate or late maternal complications, which are not specific because they can occur after a normal delivery. The objectives of this work are to describe the epidemiological-clinical and prognosis aspects of deliveries assisted by instrumental extractions in a reference maternity unit in Dakar.?Materials and Methods:?This was a retrospective, descriptive and analytical study between January 1, 2017 and December 31, 2017, a period of 12 months at the maternity ward of the Nabil Choucair Health Center. The collection was carried out using the survey form completed on the basis of the analysis of the files, the delivery register and the anaesthesia register of the operating room. The parameters studied were about socio-demographic?characteristics, indications and prognosis. The data entry was carried out using the Sphinx version 5 software and the data analysis using the Epi info version?3.5?software. Results:?During the period of our study, we collected 94 instrumental?extractions. The frequency of instrumental extractions was?1.7%. The average age of the patients was 25 years with extremes of 16 to 43 years old. The average parity was 1 with extremes 1 to 6. Among parturient women, 12?patients (12.8%) had a history of suction cup, two (2.1%) had received forceps and three (3.2%) had a cesarean section. The average gestational age was 39 Weeks of Amenorrhea (WA), the average uterine?height was 32?cm, fetal heart sounds were normal in 98% parturient’ cases. The vaginal?touch had found a fully dilated cervix, a rupture of the amniotic sac with clear amniotic?fluid in 98% of parturient women and a fetus with an anterior left iliac occipito topin 69.4% of cases. The pelvis was clinically normal in all parturient women. The indications were dominated by maternal fatigue (65.9%). The spatula was the?most commonly used instrument (82.7%). Episiotomy was performed in 97.3%?of cases. The average weight of the newborn was 3058 grams and an Apgar score of 8/10 was noted in 96% of newborns. We noted 3?cases of maternal complications with perineal tear type (3.2%) and 1 case of perineal tear associated with postpartum hemorrhage (1.06%). The neonatal prognosis was dominated by 2 caput succedaneum cases (2.1%). Newborns were alive and well in 97.8%. We noted 2 cases of death, i.e. 2.1% in?unsolved circumstances. All the mothers were alive and well at (100%). Conclusion:?Instrumental extractions must be integrated into our structures?to significantly reduce the number of abusive cesarean sections. The perfect mastery of extraction techniques and indications makes?it possible to?reduce fetal suffering while avoiding the morbidity associated with instrumental?extractions.

Management of Ovarian Cystic Tumor: Diagnosis, Management, and Its Follow-Up-Case Presentation of Three Patients and Literature Review

The diagnosis and management of ovarian cystic tumor is sometimes difficult. In this manuscript, we wish to summarize this issue by showing three cases. Ultrasound and Color Doppler are very useful to diagnose the presence of this tumor but also to distinguish between benign and malignant. Pelvic MRI is also a strong tool and is sometimes mandatory. HE4 and CA125 are often useful as a serum diagnostic marker of malignancy, but not always so. Recently, laparoscopic management has gained popularity;however, great caution should be exercised during laparoscopic operative procedures, as this may lead to intraperitoneal malignant cell spreading/proliferation when the tumor is malignant. During the surgery of malignant tumor, irrespective of laparoscopic or laparotomic, intraperitoneal rupture should be avoided. Since the final diagnosis must be made by histological examination, the patient must always be informed of this possibility.

Epidemiology and Prognosis of Retroplacental Hematoma in a Maternity Ward at a Regional Hospital Center in Southern Senegal

Objectives: To study the epidemiological profile and the prognosis of the retro-placental hematoma (HRP) at the maternity ward at Kolda Regional Hospital Center. Materials and methods: This was a retrospective descriptive cross-sectional study conducted over a period of 11 years: from January 1st, 2006 to December 31st, 2016, at Kolda Regional Hospital Center. It included all patients admitted for HRP during this period. The studied parameters concerned sociodemographic characteristics, gynecological obstetrical history;clinical, therapeutic and prognostic data (non-inclusion or exclusion criteria). The data were collected from medical records, the delivery room and the surgery room registers using a collection sheet developed for this purpose. The statistical analysis of the variables studied was done with the software Epi-info 3.5. For the qualitative variables, we calculated the frequencies and for the quantitative variables, we studied the distributions. Results: During the study period, 15,343 were recorded deliveries and we carried out the diagnosis of HRP in 301 patients (1.97%). The average age of the patients was 24 years with an average parity of 4.8 deliveries. Almost all the patients (87.5%) were evacuated and half had delivered by caesarean section. Maternal and fetal deaths were 7% and 72.1%, respectively. Uterine atony accounted for 21.2% of complications. One third of the cases of uterine atony had resulted in a hysterectomy. The average duration of hospitalization was 6 days. Conclusion: The retro-placental hematoma is a serious medico-obstetric emergency. It is burdened with high maternal and fetal morbidity and mortality in developing countries.

Diagnostic and Prognostic Epidemic Aspect of Eclampsia at the Kolda Regional Hospital Center (Senegal)

Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2018. Included were all women received in the emergency department of our health facility for generalized seizures and/or disturbances of consciousness, occurring between the 20th Week of Amenorrhea (WA) and the 6th week of postpartum on a field of hypertension. The sources of the data consisted of antenatal consultation cards, delivery records, hospital records, operating theater and resuscitation records. The variables studied were sociodemographic characteristics, the course of pregnancy, childbirth and neonatal parameters. Data were captured and analyzed using SPSS 11.0 software. Results: The study focused on 190 cases with a prevalence of 3.5%. The average age of the patients was 20 years with extremes of 14 and 40 years. The average parity was 4.1 deliveries with extremes of 1 and 7. Nearly three-quarters of the patients (74.7%) of the patients were primiparous. Almost all the patients were evacuated. More than half of the seizures (53.1%) were recorded before work and more than one out of two patients had two seizures. Caesarean section was the mode of delivery in more than one out of two patients (56.8%). Maternal complications were marked by renal failure (23 cases), the HELLP syndrome (72 cases), and the retro placental hematoma (83 cases). The fetal impact was marked by prematurity in 90% of cases and 17 cases of fetal death in-utero. Nineteen maternal deaths were recorded while early neonatal mortality was 437 per 1000 live births. The average hospital stay of the survivors was 6.2 days. Conclusion: Eclampsia is still common in our regions. It occurs preferentially in young primiparas with hypertension and/or proteinuria on a poorly followed pregnancy. Magnesium sulphate and cesarean section can improve the maternal and fetal prognosis. Prevention necessarily means quality prenatal care.

Pre-Rupture Aneurysm of the Juxta and Sub-Renal Abdominal Aorta in Early Pregnancy: A Case Report

Aneurysm of the abdominal aorta is the result of a weakening of the arterial wall and corresponds to abnormal dilatations of the arteries defined as an increase ≥ 50% of the arterial diameter compared to the normal segments. A long asymptomatic, abdominal aortic aneurysm can be a catastrophic maternal-fetal situation due to the high risk of rupture induced by pregnancy. A rare association between aneurysm and pregnancy poses a problem of diagnosis and standardized management. The lack of knowledge of this condition regularly leads to a delay in management, which is a source of excess mortality. We report the case of a patient with a progressive pregnancy of 12 weeks of amenorrhea who presented with a large sub renal abdominal aortic aneurysm with thrombosis and fissuring in order to discuss the diagnostic and management aspects of this association.

Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. Patients and methods: An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. Results and comments: We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.

Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk Gestational Trophoblastic Neoplasia

Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in developing countries where methotrexate is available, affordable and relatively safe.

Screening for Cervical Cancer by Visual Inspection with Acetic Acid (VIA) in Nabil Choucair Health Center—Dakar (Senegal)

OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.

Assessment of a Database Management System in a Mammogram Unit of a Radiologic Department in Fann Teaching Hospital (Senegal)

Objectives: To evaluate a medical data management system of a mammogram unit in a department of Radiology. Methods: This is a qualitative and quantitative assessment study in Fann Teaching Hospital between April 2014 and June 2015 one year after its implementation. The quantitative component consisted of the audit of the database to determine the socio-demographic characteristics of patients and the results of mammograms. The qualitative component assessed users’ experience. For analysis, quantitative data were extracted and transferred to Microsoft Excel. For scale variables, we calculated the averages and extremes. For qualitative variables, we established percentages. Results: During the study period, 433 patients underwent mammograms. The average age of patients was 48 years. The completion rate maintained above 85% was below 26% in the first two months of use. As to the completeness given examinations, it was still above 83%. The results of mammogram examinations were normal in the majority of cases: 96% for the right breast and 95.2% for the left breast. All users had a favourable opinion about the database. The reasons were better work organization, comprehensiveness, accessibility and standardization of information about the patient and especially the immediate availability of statistics. For 60% of these health professionals, complaints related to the use of the software were the time-consuming of filling data. Conclusion: This study mainly describes the perception of health professionals on the computerization of radiological examinations. It offers some advantages, proposes improvements and opens avenues for reflection on the globalization of the computerization of patient records in Radiology.

How to Avoid Primary Caesarean Section? A Five-Year Experience Report from a Level 2 Facility in Dakar Senegal

Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.

Improving Postpartum Haemorrhage Management Using Simulation in Senegal: Midterm Results

Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.

Imperforate Hymen about a Case

Imperforate hymen?is a congenital obstructive abnormality of the female genital tract and its incidence is estimated at 1/2000 female births. The diagnosis may go unnoticed during the examination of the new born in the birth room. Most often, this malformation is discovered at puberty.?Treatment of?Imperforate hymen?is hymenotomy or hymenectomy. Different types of incisions are mentioned in the literature. We have reported the case of a 14-year-old?girl with hematocolpos and hematometra on hymenal impforforate. In cultures and religions where the loss of the hymen is a social problem among unmarried girls, a medical certificate must be given to the patient.

A Rare Case of Holoprosencephalus with Cyclopia

Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the framework of ectroprosopia. Case presentation: This is a case report of Gravida 3 Para 3, 32 years old and without a history of abortion, with a history of normal vaginal birth which occurs during labor latency with active movements of the fetus present and cardiac activity on auscultation with pinard stethoscope. The uterine height was 32 cm with well palpated fetal poles. Ultrasound examination confirms the presence of normal cardiac activity with a poorly responsive fetus. After labor management, she gave birth 3 hours after admission to the maternity ward of a living newborn male weighing 2800 g with an Apgar score of 4/10 at the first minute and 2/10 at the fifth minute. He died 10 minutes later at the maternity hospital of the Saint-Louis regional hospital center, in northern Senegal. Conclusion: Holoprosencephaly is certainly rare but remains the most common structural congenital anomaly of the brain with a complex and multifactorial pathogenesis. Early perinatal diagnosis and determination of severity are important to inform parents of the possibilities of a future life. The voluntary termination of pregnancy is an option but remains prohibited in the country to this day for these indications.

Modern Postpartum Contraception: The Experience of Nabil Choucair Health Center, Dakar (Senegal)

Introduction: In Senegal, according to the 2017 Demographic Health Survey, about 22% of married women have an unmet need for family planning. Globally, 61% of women do not have access to postpartum family planning. Material and Method: This is a prospective, descriptive and analytical study from March 05, 2017 to January 31, 2018. The interrogation was done in the hospital ward with filling in the data collection form. The data collected was first coded and then entered, using the sphinx software. The data analysis was done with Epi info version 7 software and included a descriptive and analytical component. Results: The average age of the patients was 26 years with extremes of 15 and 48 years. Average gestation was 2.3 with extremes of 1 and 8 pregnancies. More than half of the women (64.7%) had delivered by caesarean in an emergency setting. More than half of the women (66.7%) had chosen the hormonal contraceptive method within 48 hours of delivery and the implant was the type of contraceptive prescribed in almost half of the cases (49.3%). Conclusion: Integrating postpartum family planning into programs will ultimately help to dramatically decrease high-risk pregnancies, decrease the unmet need for family planning (FP), and improve the health and survival of mothers and children.

E_Breast: A Computerized Database Management System for Breast Diseases Patients in a Low Income Country

Objectives: To report our experience in using an electronic database for management of breast diseases in a developing country. Materials and methods: E-Breast is a database developed on FileMaker Pro Advanced to serve as patient file and breast diseases registry. The development of the platform, its usage and advantages on a manual filing system are described. Results: For 6 years, we use this database, which accounts more than 2000 patients and includes data from more than 10 years. An overview of the activity is easily generated by E-Breast. The generated reports are used to the routine care of patients, statistics and clinical research. Data entered are immediately useful in addition to simultaneously implement the database for clinical research. Many custom features are integrated. For research purposes, the system has the ability to perform detailed analyses on subsets defined by the user as breast cancer, breast benign diseases, etc. Conclusion: E-Breast has proven to be a useful way of documentation that has become an integral and essential part of the daily activity and also a valuable research tool.

Ectopic Tubal Molar Pregnancy: A Case Report

Background: Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies. Aim: We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy. Case report: A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination and the histological examination show an aspect of a partial molar ectopic tubal pregnancy. Conclusion: Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.